Health care reform bill discusses medication therapy management

How will MTM improvements play out?

If hospital pharmacy directors come away with one important point from the new health care reform bill, it should be this: Develop medication therapy management (MTM) services as soon as possible.

The Patient Protection and Affordable Care Act devotes a significant amount of space to discussing MTM in conjunction with Medicare services and new health care delivery models that will be piloted. While these services often can be provided by community pharmacists, hospital pharmacies also can play a leading role.

"These medication therapy management services are specific to licensed pharmacists," says Kristina E. Lunner, vice president of government affairs for the American Pharmacists Association of Washington, DC.

"These include proposals to develop integrated delivery models, like an accountable care organization, a community health team, and they include references to including pharmacists on the team," Lunner says. "Then there's also an independence at home demonstration program, and that includes a recommendation of having pharmacists on the care team."

So the new bill recognizes the importance of addressing medication use through MTM and that pharmacists should play a role whenever medications are utilized, she adds.

Take the bill's section 3503, for example. This section, which was begun May 1, 2010, is about medication management services in the treatment of chronic disease. It directs the Secretary of the Department of Health and Human Services (HHS), through the Patient Safety Research Center, to establish a program to provide grants to eligible entities to implement medication management or MTM services provided by licensed pharmacists.

These services would be "a collaborative, multidisciplinary, interprofessional approach to the treatment of chronic diseases for targeted individuals, to improve the quality of care and reduce overall cost in the treatment of such diseases," the bill states.

Some of the specific MTM services that will be provided are described as follows:

  • Performing or obtaining necessary assessments of the health and functional status of each patient receiving such MTM services;
  • Formulating a medication treatment plan according to therapeutic goals agreed upon by the prescriber and the patient or caregiver or authorized representative of the patient;
  • Selecting, initiating, modifying, recommending changes to, or administering medication therapy;
  • Monitoring, which may include access to, ordering, or performing laboratory assessments, and evaluating the response of the patient to therapy, including safety and effectiveness;
  • Performing an initial comprehensive medication review to identify, resolve, and prevent medication-related problems, including adverse drug events, quarterly targeted medication reviews for ongoing monitoring, and additional follow-up interventions on a schedule developed collaboratively with the prescriber.

"My initial read is that most of the MTM would be delivered in an integrated care model, in an outpatient setting," Lunner says.

"However, there are provisions to reduce hospital readmissions and these address medication use," she adds. "In these provisions there are opportunities for pharmacists working in the hospital inpatient setting to participate."